Tzanck smear as an accurate and rapid diagnostic tool for cutaneous alternariosis in a renal transplant recipient

Alternaria species are becoming increasingly important opportunistic pathogens in recipients of solid organ transplant, as it has been shown that dissemination with systemic involvement is not as rare as previously reported. Therefore, rapid and accurate diagnosis is necessary for appropriate patient management. We report a patient with renal transplant who developed recurrent cutaneous alternariosis. Tzanck smear successfully and very rapidly revealed hyphae and spores in both the primary and subsequent lesions. Furthermore, Tzanck smear provided guidance for histopathological examination of the second lesion, which failed to disclose the fungal elements until additional deeper serial sections were performed. The present case emphasizes that the Tzanck smear is a useful clinical tool leading to the immediate correct diagnosis even in deep fungal infections.